Clinical Strategies For Managing Resistant Hypertension: Emerging Tools and Therapeutic Insights - Episode 7
Subanalysis in Black Individuals From the PRECISION Trial
Panelists discuss how the PRECISION trial subanalysis showed aprocitentan worked equally well in Black patients as in White patients, which is particularly important given the higher prevalence and complications of resistant hypertension in Black populations, with emphasis on adequate diuretic management to prevent peripheral edema.
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The PRECISION trial’s subgroup analysis in Black patients demonstrated equivalent efficacy and safety compared with White patients, addressing critical concerns about racial disparities in hypertension treatment response. This finding is particularly significant given that Black patients experience disproportionately higher rates of resistant hypertension, cardiovascular complications, and chronic kidney disease, making effective treatment options essential for reducing health disparities.
Historical concerns about differential antihypertensive responses between racial groups, particularly the perception that Black patients respond better to diuretics than ACE inhibitors or ARBs, are challenged by the PRECISION results showing universal benefit from endothelin receptor antagonism. While initial blood pressure reduction rates may vary between drug classes and racial groups, long-term cardiovascular and renal protection appears consistent across populations when optimal blood pressure control is achieved.
The equivalent response to aprocitentan in Black patients is especially important given their higher prevalence of salt sensitivity and genetic factors like APOL1 variants that increase cardiovascular and renal risk. Clinical management considerations include ensuring adequate diuretic therapy to prevent fluid retention, monitoring BUN-to-creatinine ratios to optimize fluid balance, and recognizing that genetic predisposition combined with dietary and environmental factors creates particular urgency for effective blood pressure control in this high-risk population.
